Provider Demographics
NPI:1316201932
Name:MENON, RACHEL L (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:MENON
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 PAMELAS LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-2362
Mailing Address - Country:US
Mailing Address - Phone:941-374-7224
Mailing Address - Fax:
Practice Address - Street 1:802 PAMELAS LN
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2362
Practice Address - Country:US
Practice Address - Phone:617-419-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23226363A00000X
MEPA1611363A00000X
MAPA4424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400309764Medicare PIN